Effects of Non-Steroidal Anti-Inflammatory Drugs to the GastrointestinalTract

Overview

Non-steroidal anti-inflammatory drugs (NSAID) belong to the most commonly used drugs worldwide. NSAIDscan cause serious side effects to the gastrointestinal tract. During NSAIDs treatment 10–12 % patients suffer fromdyspepsia. Up to 1 % patients develop severe gastrointestinal complications (ulcer, bleeding, perforation). Any partof gastrointestinal tract could be affected. In oesophagus, NSAIDs can cause oesophagitis or fibrous stricture. NSAIDgastropathy can be detected in 40 % patients chronically treated with NSAIDs. NSAIDs toxic injury to small andlarge bowel is frequent but only seldom properly recognised. Serious hepatic lesions are rare. There is no fullyreliable and sure prophylaxis or treatment of NSAIDs impairment of to the gastrointestinal tract. Rate of side effectscan be reduced by reasonable prescriptions and by primary and secondary prophylaxis. Low rate of side effects isassociated with the use of pro-drugs (compound is metabolised to an active substance after absorption from thegastrointestinal tract). New promising drugs were developed with dual action (5-lipoxygenase- and COX-inhibition)and NSAID releasing NO (nitronaproxen, nitrophenac). Specific COX-2 inhibitors (coxibes) provide comparableanti-inflammatory and analgesic effect but the risk of serious side effects to the gastrointestinal tract is significantlylower (when compared with non-specific NSAIDs). Beside harmful effects, NSAIDs are powerful tool in chemopreventionof colorectal cancer.

Key words:
non-steroidal anti-inflammatory drugs, NSAID, side effects, gastrointestinal tract.